Am J Perinatol 2023; 40(07): 741-747
DOI: 10.1055/s-0041-1730436
Original Article

Neonatal Outcomes of Infants Born to Women on Hemodialysis: A Single-Center, Case-Control Study

1   Neonatal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
,
Masaki Wada
1   Neonatal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
,
Masaki Ogawa
2   Maternal-Fetal Division, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
,
Ken Tsuchiya
3   Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan
,
Satoshi Kusuda
4   Department of Pediatrics, Kyorin University, Tokyo, Japan
› Institutsangaben
Funding None.

Abstract

Objective The study aimed to investigate the neonatal outcomes of infants born to mothers on hemodialysis.

Study Design This retrospective, case-control, and observational study included 17 infants born to 16 mothers on dialysis in 2003 to 2016. We compared their clinical characteristics to those of 51 gestational age- and sex-matched control infants. Statistical comparisons were made between the two groups by using the Wilcoxon–Mann–Whitney test for continuous variables and the Chi-square test or Fisher's exact test for categorical variables.

Results Of the 16 pregnancies of mothers on dialysis, 15 (94%) deliveries were premature (<37 weeks), and 16/17 (94%) infants survived to discharge. The incidences of neonatal complications, such as intraventricular hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosus, and periventricular leukomalacia, were not significantly different between the groups. However, 5/17 (29%) of the infants had congenital anomalies.

Conclusion Although infants born to mothers on dialysis have a high risk of prematurity, they do not have any additional risk of neonatal complications, except for congenital anomalies. The potential risk of congenital anomalies should be investigated further.

Key Points

  • Preterm birth rate among mothers on hemodialysis was 94%.

  • Complications in these infants were similar to controls.

  • Twenty-nine percent of infants had congenital anomalies.

Authors' Contributions

K.I. designed the study, collected clinical data, drafted the initial manuscript, and revised the manuscript. M.O. reviewed and revised the manuscript for obstetrical content. K.T. assisted in data interpretation and revised the manuscript for content regarding kidney disease and hemodialysis. M.W. and S.K. coordinated and supervised the study and critically reviewed the manuscript.


Supplementary Material



Publikationsverlauf

Eingereicht: 27. Oktober 2020

Angenommen: 23. April 2021

Artikel online veröffentlicht:
31. Mai 2021

© 2021. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Confortini P, Galanti G, Ancona G, Giongo A, Bruschi E, Lorenzini E. Full-term pregnancy and successful delivery in a patient on chronic hemodialysis. Proc Eur Dial Transplant Assoc 1971; 8: 74-78
  • 2 Registration Committee of the European Dialysis and Transplant Association. Successful pregnancies in women treated by dialysis and kidney transplantation. Report from the Registration Committee of the European Dialysis and Transplant Association. Br J Obstet Gynaecol 1980; 87 (10) 839-845
  • 3 Furaz-Czerpak KR, Fernández-Juárez G, Moreno-de la Higuera MÁ, Corchete-Prats E, Puente-García A, Martín-Hernández R. Pregnancy in women on chronic dialysis: a review. Nefrologia 2012; 32 (03) 287-294
  • 4 Toma H, Tanabe K, Tokumoto T, Kobayashi C, Yagisawa T. Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant 1999; 14 (06) 1511-1516
  • 5 Hladunewich MA, Hou S, Odutayo A. et al. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison. J Am Soc Nephrol 2014; 25 (05) 1103-1109
  • 6 Luders C, Castro MC, Titan SM. et al. Obstetric outcome in pregnant women on long-term dialysis: a case series. Am J Kidney Dis 2010; 56 (01) 77-85
  • 7 Okundaye I, Abrinko P, Hou S. Registry of pregnancy in dialysis patients. Am J Kidney Dis 1998; 31 (05) 766-773
  • 8 Asamiya Y, Otsubo S, Matsuda Y. et al. The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age. Kidney Int 2009; 75 (11) 1217-1222
  • 9 Romão Jr JE, Luders C, Kahhale S. et al. Pregnancy in women on chronic dialysis. A single-center experience with 17 cases. Nephron 1998; 78 (04) 416-422
  • 10 Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G. Pregnancy and dialysis. Am J Kidney Dis 1998; 31 (05) 756-765
  • 11 Chao AS, Huang JY, Lien R, Kung FT, Chen PJ, Hsieh PC. Pregnancy in women who undergo long-term hemodialysis. Am J Obstet Gynecol 2002; 187 (01) 152-156
  • 12 Eroğlu D, Lembet A, Ozdemir FN. et al. Pregnancy during hemodialysis: perinatal outcome in our cases. Transplant Proc 2004; 36 (01) 53-55
  • 13 Haase M, Morgera S, Bamberg C. et al. A systematic approach to managing pregnant dialysis patients--the importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant 2005; 20 (11) 2537-2542
  • 14 Barua M, Hladunewich M, Keunen J. et al. Successful pregnancies on nocturnal home hemodialysis. Clin J Am Soc Nephrol 2008; 3 (02) 392-396
  • 15 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
  • 16 Natarajan G, Shankaran S. Short- and long-term outcomes of moderate and late preterm infants. Am J Perinatol 2016; 33 (03) 305-317
  • 17 Japanese Society of Nephrology. Clinical guidelines for the management of pregnancy in kidney disease patients 2017 [Internet]. Tokyo, Japan: Japanese Society of Nephrology. [84 pages] (in Japanese). Accessed September 1, 2020 at: http://cdn.jsn.or.jp/data/jsn-pregnancy.pdf
  • 18 Lencki SG, Maciulla MB, Eglinton GS. Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis. Am J Obstet Gynecol 1994; 170 (5 Pt 1): 1345-1351
  • 19 Itabashi K, Miura F, Uehara R, Nakamura Y. New Japanese neonatal anthropometric charts for gestational age at birth. Pediatr Int 2014; 56 (05) 702-708
  • 20 Blowey DL, Warady BA. Outcome of infants born to women with chronic kidney disease. Adv Chronic Kidney Dis 2007; 14 (02) 199-205
  • 21 Nakabayashi M, Adachi T, Itoh S, Kobayashi M, Mishina J, Nishida H. Perinatal and infant outcome of pregnant patients undergoing chronic hemodialysis. Nephron 1999; 82 (01) 27-31
  • 22 Bamberg C, Diekmann F, Haase M. et al. Pregnancy on intensified hemodialysis: fetal surveillance and perinatal outcome. Fetal Diagn Ther 2007; 22 (04) 289-293
  • 23 Hou SH. Pregnancy in women on haemodialysis and peritoneal dialysis. Baillieres Clin Obstet Gynaecol 1994; 8 (02) 481-500
  • 24 Reddy SS, Holley JL. Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Dis 2007; 14 (02) 146-155
  • 25 Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999; 33 (02) 235-252
  • 26 Dolk H, Loane M, Garne E. The prevalence of congenital anomalies in Europe. Adv Exp Med Biol 2010; 686: 349-364
  • 27 Centers for Disease Control and Prevention (CDC). Update on overall prevalence of major birth defects--Atlanta, Georgia, 1978-2005. MMWR Morb Mortal Wkly Rep 2008; 57 (01) 1-5
  • 28 Piccoli GB, Cabiddu G, Daidone G. et al; Italian Study Group “Kidney and Pregnancy”. The children of dialysis: live-born babies from on-dialysis mothers in Italy--an epidemiological perspective comparing dialysis, kidney transplantation and the overall population. Nephrol Dial Transplant 2014; 29 (08) 1578-1586